Assessing the quality of early intervention with families

1
Assessing the quality of early intervention with
families

• Professor Alys Young
• Dr Maria Gascon-Ramos, Dr Malcolm Campbell,
  Professor John Bamford
• Social Research with Deaf People (SORD) group
• The University of Manchester, UK
• alys.young_at_manchester.ac.uk

2
Growing interest in quality

• Why important?
• Early identification quality early intervention
  improved outcomes
• Family as vital element in understanding
  differential outcomes
• Important for better targeting of services

3

• Quality as structure and framework of services
• Standards
• Training/skills
• Service elements
• Best practice
• Quality as process
• How services are provided
• How professionals behave
• Preferred underpinning philosophies
• E.g. Family centred practice
• Informed choice

4
Quality

• Quality has objective definitions, markers and
  standards
• And
• Quality is something perceived/experienced and
  identified as meaningful

5
Quality problems

• Quality as something that makes a measurable
  difference may be problematic if it does not
  consider the significance of the difference or
  how it is appraised
• Quality as something subjectively
  perceived/defined maybe problematic? we only
  judge by own standards/ experiences

6
Designing a parent-report quality instrument

• Allow us to have descriptions of input both
  structures and processes
• Allow us a window into the relevance/meaningfulnes
  s of the input
• Allow us to see how perception changes with time
• Allow us to take into consideration parents
  personal dispositions

7
Written questionnaire parents - 6 monthly
intervals

• a description of the structure of professional
  services
• evaluated according to timeliness and
  availability
• (2) the content of intervention
• evaluated according to importance, quantity and
  satisfaction
• (3) the process of the intervention
• evaluated according to extent and importance
• (4) the overall impact of the intervention
• in terms of child, family and parent themselves

8
(No Transcript)
9
Content of intervention (22 items)
10
18 items
11
6 items
12
Other instruments

• Short form TEIQue Trait Emotional Intelligence
  Questionnaire
• Enables control for disposition
• Well being, emotionality, self control,
  sociability
• Basic demographics and child characteristics

13

• Instrument properties

14
Content of Intervention Scale development

• Two subscales to measure content of support with
  good reliability were identified
• Supporting a deaf child (a0.87)
• Supporting parents (a0.86)
• Inter-scale correlation was high (r0.75)
• Test-retest correlations were also high after
• 6 month (rho0.88 r 0.682 )
• 12 months (rho0.595 r0.817)

15
Examples from sub scales

• Supporting a deaf child
• Information about how to communicate with my deaf
  child
• Confidence building in parenting a deaf child
• Knowledge about how to play with and enjoy my
  deaf child
• Supporting parents
• Help to understand how professional support
  systems work
• Emotional support for you and your family
• Advocacy (making my needs known)

16
Process of intervention scale development

• Content validity based on review of Family
  Centred Practice
• Reliability High internal consistency (a0.93)
• All 18 statements necessary to achieve such a
  high level
• Reliability did not improve with deletion of any
  statements
• Suggests high construct validity for Family
  Centred Practice Scale

17

• Some results??

18
Questionnaire returns

• At entry 82
• 6 months later 52
• 12 months later 23
• Distributions of key variables were examined to
  determine the use of parametric or nonparametric
  analyses.

19
Perceived Importance of Content of EI

• Ratings of importance for both sub scales were
  high
• Supporting Deaf Child were rated as important or
  very important (mean 3.5 SD 0.52 n73)
• Supporting Parents took a second place (mean
  2.95 SD 0.59 n73)
• BUT Intervention that equips parents to support
  their deaf child is consistently rated as more
  important than content that addresses their
  personal support.
• Differences between ratings of importance in both
  subscales were statistically significant (paired
  t 12.03 plt 0.001) and highly correlated
  (r0.75 plt 0.001).

20
Did length of involvement with EI change
perceptions of importance?

• Comparisons made between
• At entry and 6 months later
• 6 months and 12 months
• High importance persisted on both sub scales
• No statistically significant differences on
  either sub scale between ratings at different
  time points, or in the relationship between the 2
  sub scales
• Perceived importance of content remains stable
• Perceived higher importance of content relating
  specifically to supporting a deaf child remains
  stable

21
Did emotional intelligence make a difference?

• Mothers TEIQue did not correlate significantly
  with ratings of perceived importance of content
  of intervention (overall, nor on either sub scale)

SDC SDC SP SP
r p r p
Global Trait EI 0.05 0.62 0.11 0.34
Well being 0.07 0.49 0.13 0.24
Self-control 0.14 0.20 0.15 0.18
Emotionality -0.01 0.92 0.04 0.69
Sociability -0.03 0.73 -0.02 0.86
22
Did educational background matter?

• YES Mothers with fewer qualifications rated the
  importance of content relating to supporting them
  more highly than those with higher
  qualifications. Supporting Parents sub scale
  (F4.23 p0.008)
• Ratings on the SDC sub scale not affected by
  education

SDC SDC SP SP
Median SD Mean SD
No qualifications 3.8 0.2 3.3. 0.7
High school 3.6 0.2 3.1 0.5
Higher education certificate 3.7 0.3 3.2 0.4
Higher education degree, NVQ 6 3.7 0.5 2.7 0.5
23
Parents Satisfaction with Content of EI

• Parents satisfaction scores on the Supporting a
  Deaf Child subscale were higher (mean 3.4, SD
  0.9) than on the Supporting Parents subscale
  (mean 3.1, SD 0.8)
• The difference is statistically significant (t
  3.24, df 55, p 0.002).
• Result not affected by age of child, degree of
  hearing loss, disability.

24
Does length of involvement make a difference?
SDC r p T df p
At entry 6 m 0.68 0.001 1.35 41 0.185
At entry 12 m 0.64 0.006 -0.82 16 0.425
At entry (mean 3.5 SD 1.0) 6 months (mean 3.3 SD 0.9) 12 months (mean 3.5 SD 0.9) At entry (mean 3.5 SD 1.0) 6 months (mean 3.3 SD 0.9) 12 months (mean 3.5 SD 0.9) At entry (mean 3.5 SD 1.0) 6 months (mean 3.3 SD 0.9) 12 months (mean 3.5 SD 0.9) At entry (mean 3.5 SD 1.0) 6 months (mean 3.3 SD 0.9) 12 months (mean 3.5 SD 0.9) At entry (mean 3.5 SD 1.0) 6 months (mean 3.3 SD 0.9) 12 months (mean 3.5 SD 0.9) At entry (mean 3.5 SD 1.0) 6 months (mean 3.3 SD 0.9) 12 months (mean 3.5 SD 0.9)

• Comparing at entry with 6 mths later and 12
  months later
• Satisfaction scores do increase over time
• Not statistically significant for the SDC
  subscale
• Is statistically significant for the SP subscale

SP r p t df p
At entry 6 m 0.68 0.001 -0.39 33 0.699
At entry 12 m 0.57 0.028 -3.44 14 0.004
At entry (mean 3.1 SD 0.8) 6 months (mean 3.1 SD 0.8) 12 months (mean 3.5 SD 0.7) At entry (mean 3.1 SD 0.8) 6 months (mean 3.1 SD 0.8) 12 months (mean 3.5 SD 0.7) At entry (mean 3.1 SD 0.8) 6 months (mean 3.1 SD 0.8) 12 months (mean 3.5 SD 0.7) At entry (mean 3.1 SD 0.8) 6 months (mean 3.1 SD 0.8) 12 months (mean 3.5 SD 0.7) At entry (mean 3.1 SD 0.8) 6 months (mean 3.1 SD 0.8) 12 months (mean 3.5 SD 0.7) At entry (mean 3.1 SD 0.8) 6 months (mean 3.1 SD 0.8) 12 months (mean 3.5 SD 0.7)
25
The impact of well being

• Mothers wellbeing is correlated with
  satisfaction scores on both subscales
• Factor analysis demonstrating a statistically
  significant association with content

SDC SDC SP SP
r p r p
Global Trait EI 0.125 0.30 0.197 0.13
Well being 0.243 0.04 0.300 0.01
Self-control 0.171 0.15 0.185 0.15
Emotionality 0.130 0.27 0.153 0.23
Sociability -0.08 0.51 0.086 0.51
But mothers educational background does not
affect satisfaction scores on either sub scale
nor globally.
26
Perceived Impact and Satisfaction with content
of EI

• No statistically significant relationship was
  found between satisfaction with content of early
  intervention and perceived impact of intervention
  on the child (r 1.38, p0.191)
• However, a statistically significant relationship
  was observed between satisfaction and perceived
  impact of intervention on the parent as an
  individual (r0.318, p0.002) and on the family
  (r0.320, p0.002).

27
Conclusions

• All content is important and its perceived
  importance increases over time
• But that which is perceived to be specific to the
  difference of the deaf child is more
  significant in the early stages regardless of
  maternal disposition and child specific
  characteristics
• initial appraisals of the importance of content
  of intervention were the best predictor of
  appraisals 6 months later, over an above any
  differences associated with child characteristics
  (e.g. degree of deafness).
• Importance attributed to specialist content not
  affected by maternal education.
• But importance attributed to personal support was
  affected by maternal education those with fewer
  qualifications attributed greater importance.

28
Conclusions cont.

• Significant higher satisfaction ratings were
  associated with content of intervention linked to
  supporting a deaf child, in comparison with that
  supporting parents.
• satisfaction with content associated with
  supporting parents did increase with length of
  involvement in intervention
• Unlike in ratings of the importance of content of
  intervention, maternal well being is consistently
  associated with satisfaction of content of
  intervention
• Satisfaction with content is more closely
  associated with impact on parent and family,
  rather than impact on child

29
References

• Young, A.M., Gascon-Ramos, M., Campbell, M.
  Bamford, J. (2009) The Design and Validation of a
  Parent-Report Questionnaire for Assessing the
  Characteristics and Quality of Early Intervention
  OverTime. The Journal of Deaf Studies and Deaf
  Education. Free full text http//jdsde.oxfordjou
  rnals.org/cgi/content/full/14/4/422
• Gascon-Ramos, M., Campbell, M., Young, A.M. (2009
  under review). Influences on parental evaluation
  of the content of early intervention following
  early identification of deafness. Child Care,
  Health and Development
• To register to access a copy of the MVOS
• http//www.nursing.manchester.ac.uk/research/resea
  rchgroups/socialwork/sord/

30

• Alys.young_at_manchester.ac.uk